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Fulltext Pre-operative Factors Predicting Mortality in Six Months and Functional Recovery in Elderly Patients with Hip Fractures

Nam NH, Minh ND, Hai TX, Sinh CT, Loi CB, Anh LT

Malays Orthop J, 2023 Mar;17(1):10-17.
PMID: 37064636 DOI: 10.5704/MOJ.2303.002

INTRODUCTION: This study aimed to determine on-admission and perioperative factors predicting six-month mortality and functional recovery in Vietnamese patients with hip fracture.
MATERIALS AND METHODS: Between April 2020 and July 2021, 118 patients participated in this prospective study. Patients' data were collected from medical records. Harris hip score (HHS) was used to evaluate the functional recovery six months after fractures. The obtained data were analysed using a univariate and multivariate model.
RESULTS: The mean age of the participants was 79.5±9.4 years and 68.6% of the patients were female. The six-month mortality rate was 5.9% and independently associated with age (odds ratio (OR): 3.512, 95% confidence interval (CI) 1.538 - 8.019; P<0.001, patients aged >80 years vs those aged ≤80 years) and hypoproteinemia (OR: 2.859, 95% CI: 1.001 - 8.166, P=0.049). Among 111 survivors there were 66 (59.5%) of patients with a good functional recovery. Patients aged >80 years had a higher risk of poor functional outcome (OR: 3.167, 95% CI: 1.386 - 7.235, P: 0.006) compared to those aged ≤ 80 years. No significant correlations between other clinical (gender, body mass index, comorbidities, type of fractures or surgery, time until surgery) or laboratory parameters (anaemia, hyperglycemia, marked elevation of C reactive protein level, electrolyte abnormalities, elevated urea) and mortality or functional outcome were found.
CONCLUSION: Advanced age is the most important factor affecting both mortality and functional outcome while hypoproteinemia is associated with a higher risk of mortality in elderly patients with hip fractures.
Validation study of AR Gynae endotrainer - a new mobile laparoscopic simulator

Omar AA, Zon EM, Ismail MP, Mahdi M, Ibrahim A, Engku-Husna EI, et al.

Med J Malaysia, 2023 Nov;78(6):711-716.
PMID: 38031211

INTRODUCTION: In gynaecology, laparoscopy is the choice of treatment for a lot of procedures as it is considered safe and effective. However, laparoscopic surgery requires skills that are different from those required for open surgery. In order to acquire the skills, a surgeon needs specific training. The aim of this study was to validate the AR Gynae endotrainer, a new mobile laparoscopic simulator, as a comparable box trainer for gynaecology laparoscopic training, comparing it with the well-established Karl Storz SZABO-BERCISACKIER laparoscopic trainer.
MATERIALS AND METHODS: A randomised prospective crossover study was designed to compare the AR Gynae endotrainer versus Karl Storz SZABO-BERCI-SACKIER laparoscopic trainer as a tool for training gynaecology laparoscopic skills. Participants were assigned to perform two specially designed tasks used for laparoscopic training using both endotrainers. All subjects evaluated both simulators concerning their performance by the use of a questionnaire comparing: design, ports placement, visibility, ergonomics, triangulation of movement, fulcrum effect, depth perception, ambidexterity, resources for training, and resources for teaching. The overall score was defined as the median value obtained. The ability and time taken for participants to complete the tasks using both endotrainers were also compared. A total of 26 participants were enrolled in this study, including 13 Masters's students from the Department of Obstetrics & Gynaecology and 13 Masters's students from the Department of Surgery, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.
RESULTS: A better performance was observed with AR Gynae as compared to Karl Storz endotrainer in five out of ten items evaluated in the questionnaire. Additionally, the overall score of AR Gynae endotrainer (median of 3.98) was comparable to that of Karl Storz endotrainer (median of 3.91) with p=0.519. For the items design and resources for teaching, the evaluation for AR Gynae endotrainer was significantly higher with p-values of 0.003 and 0.032, respectively. All participants were able to complete both tasks using both endotrainers. The time taken to complete both tasks was comparable on both endotrainers. Also, the AR Gynae endotrainer was cheaper.
CONCLUSIONS: The AR Gynae endotrainer was found to be a convenient and cost-effective laparoscopic simulator for gynaecology laparoscopic training and was comparable to the established Karl Storz SZABO-BERCI-SACKIER laparoscopic trainer.
Fulltext Lung disease recognition methods using audio-based analysis with machine learning

Sabry AH, I Dallal Bashi O, Nik Ali NH, Mahmood Al Kubaisi Y

Heliyon, 2024 Feb 29;10(4):e26218.
PMID: 38420389 DOI: 10.1016/j.heliyon.2024.e26218

The use of computer-based automated approaches and improvements in lung sound recording techniques have made lung sound-based diagnostics even better and devoid of subjectivity errors. Using a computer to evaluate lung sound features more thoroughly with the use of analyzing changes in lung sound behavior, recording measurements, suppressing the presence of noise contaminations, and graphical representations are all made possible by computer-based lung sound analysis. This paper starts with a discussion of the need for this research area, providing an overview of the field and the motivations behind it. Following that, it details the survey methodology used in this work. It presents a discussion on the elements of sound-based lung disease classification using machine learning algorithms. This includes commonly prior considered datasets, feature extraction techniques, pre-processing methods, artifact removal methods, lung-heart sound separation, deep learning algorithms, and wavelet transform of lung audio signals. The study introduces studies that review lung screening including a summary table of these references and discusses the literature gaps in the existing studies. It is concluded that the use of sound-based machine learning in the classification of respiratory diseases has promising results. While we believe this material will prove valuable to physicians and researchers exploring sound-signal-based machine learning, large-scale investigations remain essential to solidify the findings and foster wider adoption within the medical community.
Respirable dust exposure impact on respiratory symptoms among cleaners in a Selangor Public University, Malaysia

Aziz NAI, Feisal NAS, Ibrahim TNBT, Cheah WY, Kamaludin NH

Med J Malaysia, 2024 Mar;79(Suppl 1):110-116.
PMID: 38555894

INTRODUCTION: Cleaners perform a vital role in environmental health by keeping the place clean, but they are also exposed to various hazards. Yet, there is a lack of effective and accessible occupational safety standard measures, thus making this to be difficult to monitor the long-term health effects of cleaners. This study aims to determine the respirable dust exposure on respiratory symptoms among cleaners in a public university in Selangor.
MATERIALS AND METHODS: A cross-sectional study was carried out among 51 cleaners. The respondents' background information and respiratory symptoms were gathered using a series of standardised questionnaires validated by the American Thoracic Society (ATS-DLD-78-A). The 8- hour respirable dust exposure to cleaners was measured using an air sampling pump (Gillian & Sensodyne Gil Air 3).
RESULTS: The mean of respirable dust was lower than permissible exposure limit with 0.63±0.57mg/m3. The respiratory symptoms among the cleaners showed no significant association between cough, phlegm, and breathing difficulties with working tenure. Meanwhile, wheezing and coughing with phlegm have an almost significant association with working tenure among cleaners with (Χ2=1.00, p=0.08) and (Χ2=1.00, p=0.07) respectively. Exposure to respirable dust has exhibited 6 times the prevalence of coughing with phlegm among cleaners (PR=6.28, 95% CI: 0.44, 89.38).
CONCLUSION: The findings of this study demonstrated that the cleaners were significantly affected by the respirable dust. The cleaners' working environment has caused them to be exposed to respirable dust.
Fulltext Benzylidene derivatives of andrographolide inhibit growth of breast and colon cancer cells in vitro by inducing G(1) arrest and apoptosis

Jada SR, Matthews C, Saad MS, Hamzah AS, Lajis NH, Stevens MF, et al.

Br J Pharmacol, 2008 Nov;155(5):641-54.
PMID: 18806812 DOI: 10.1038/bjp.2008.368

BACKGROUND AND PURPOSE: Andrographolide, the major phytoconstituent of Andrographis paniculata, was previously shown by us to have activity against breast cancer. This led to synthesis of new andrographolide analogues to find compounds with better activity than the parent compound. Selected benzylidene derivatives were investigated for their mechanisms of action by studying their effects on the cell cycle progression and cell death.
EXPERIMENTAL APPROACH: Microculture tetrazolium, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and sulphorhodamine B (SRB) assays were utilized in assessing the in vitro growth inhibition and cytotoxicity of compounds. Flow cytometry was used to analyse the cell cycle distribution of control and treated cells. CDK1 and CDK4 levels were determined by western blotting. Apoptotic cell death was assessed by fluorescence microscopy and flow cytometry.
KEY RESULTS: Compounds, in nanomolar to micromolar concentrations, exhibited growth inhibition and cytotoxicity in MCF-7 (breast) and HCT-116 (colon) cancer cells. In the NCI screen, 3,19-(2-bromobenzylidene) andrographolide (SRJ09) and 3,19-(3-chloro-4-fluorobenzylidene) andrographolide (SRJ23) showed greater cytotoxic potency and selectivity than andrographolide. SRJ09 and SRJ23 induced G(1) arrest and apoptosis in MCF-7 and HCT-116 cells, respectively. SRJ09 downregulated CDK4 but not CDK1 level in MCF-7 cells. Apoptosis induced by SRJ09 and SRJ23 in HCT-116 cells was confirmed by annexin V-FITC/PI flow cytometry analysis.
CONCLUSION AND IMPLICATIONS: The new benzylidene derivatives of andrographolide are potential anticancer agents. SRJ09 emerged as the lead compound in this study, exhibiting anticancer activity by downregulating CDK4 to promote a G(1) phase cell cycle arrest, coupled with induction of apoptosis.
Fulltext The Antiproliferative Activity of Sclerotia of Lignosus rhinocerus (Tiger Milk Mushroom)

Lee ML, Tan NH, Fung SY, Tan CS, Ng ST

Evid Based Complement Alternat Med, 2012;2012:697603.
PMID: 22454675 DOI: 10.1155/2012/697603

Lignosus rhinocerus, the tiger milk mushroom, is one of the most important medicinal mushrooms used by the indigenous people of Southeast Asia and China. It has been used to treat breast cancer. A cold water extract (LR-CW) prepared from the sclerotia of L. rhinocerus cultivar was found to exhibit antiproliferative activity against human breast carcinoma (MCF-7) and human lung carcinoma (A549), with IC(50) of 96.7 μg/mL and 466.7 μg/mL, respectively. In comparison, LR-CW did not show significant cytotoxicity against the two corresponding human normal cells, 184B5 (human breast cell) and NL 20 (human lung cell). DNA fragmentation studies suggested that the cytotoxic action of LR-CW against cancer cells is mediated by apoptosis. Sephadex G-50 gel filtration fractionation of LR-CW yielded a high-molecular-weight and a low-molecular-weight fraction. The high-molecular-weight fraction contains mainly carbohydrate (68.7%) and small amount of protein (3.6%), whereas the low-molecular-weight fraction contains 31% carbohydrate and was devoid of protein. Only the high-molecular-weight fraction exhibited antiproliferative activity against cancer cells, with IC(50) of 70.0 μg/mL and 76.7 μg/mL, respectively. Thus, the cytotoxic action of the LR-CW is due to the high-molecular-weight fraction, either the proteins or protein-carbohydrate complex.
Fulltext Tetraalkylammonium salts (TAS) in solar energy applications - A review on in vitro and in vivo toxicity

Mustafa NM, Jumaah FN, Ludin NA, Akhtaruzzaman M, Hassan NH, Ahmad A, et al.

Heliyon, 2024 Apr 15;10(7):e27381.
PMID: 38560257 DOI: 10.1016/j.heliyon.2024.e27381

Tetraalkylammonium salt (TAS) is an organic salt widely employed as a precursor, additive or electrolyte in solar cell applications, such as perovskite or dye-sensitized solar cells. Notably, Perovskite solar cells (PSCs) have garnered acclaim for their exceptional efficiency. However, PSCs have been associated with environmental and health concerns due to the presence of lead (Pb) content, the use of hazardous solvents, and the incorporation of TAS in their fabrication processes, which significantly contributes to environmental and human health toxicity. As a response, there is a growing trend towards transitioning to safer and biobased materials in PSC fabrication to address these concerns. However, the potential health hazards associated with TAS necessitate a thorough evaluation, considering the widespread use of this substance. Nevertheless, the overexploitation of TAS could potentially increase the disposal of TAS in the ecosystem, thus, posing a major health risk and severe pollution. Therefore, this review article presents a comprehensive discussion on the in vitro and in vivo toxicity assays of TAS as a potential material in solar energy applications, including cytotoxicity, genotoxicity, in vivo dermal, and systemic toxicity. In addition, this review emphasizes the toxicity of TAS compounds, particularly the linear tetraalkyl chain structures, and summarizes essential findings from past studies as a point of reference for the development of non-toxic and environmentally friendly TAS derivatives in future studies. The effects of the TAS alkyl chain length, polar head and hydrophobicity, cation and anion, and other properties are also included in this review.
Effectiveness of Pamidronate Infusion in the Treatment of Charcot Arthropathy

Bajuri MY, Md-Noorpi NH, Yin MK, Azman I, Adib-Adham NS

Malays Orthop J, 2024 Mar;18(1):66-72.
PMID: 38638656 DOI: 10.5704/MOJ.2403.009

INTRODUCTION: The objective of this case series is to investigate the efficacy and safety of intravenous infusion of Pamidronate, a second generation bisphosphonate, in the treatment of active Charcot arthropathy.
MATERIALS AND METHODS: All patients with active Charcot arthropathy treated at the medical centre from 1 January 2013 to 30 June 2020 were included in the study. Efficacy outcome was evaluated based on time to consolidate findings observed through radiographic examination, while safety outcome was evaluated based on the incidence of adverse event (AE) occurrence.
RESULTS: A total of 81 patients (37 male, 44 female) diagnosed with active Charcot arthropathy were included. 64.2% of patients were at stage 1 of Charcot arthropathy whereas 35.8% were at stage 2. The mean time to consolidate for stage 1 and stage 2 was 6.50 ± 4.21 months and 3.63 ± 2.92 months respectively (p-value = 0.139). No significant association was observed between gender, ethnicity and disease stage with the consolidation time (p-value >0.05). The rate of AE incidence was 2.5%, observed in 2 patients who developed a fever during the treatment. No other serious AE was observed in the study.
CONCLUSION: Intravenous Pamidronate infusion is a safe and effective treatment option for Charcot arthropathy.
Novel Vibrio vulnificus sequence type 540 infection in a hepatitis patient

Chua HS, Soh YH, Ibrahim S, Abdullah NH, Che Mat Seri NAA, AbuBakar S, et al.

Trop Biomed, 2024 Jun 01;41(2):220-223.
PMID: 39154277 DOI: 10.47665/tb.41.2.014

Vibrio vulnificus infection is associated with high morbidity and mortality in high-risk patients. Poor prognoses could lead to >50% mortality rate. The present report describes a case of V. vulnificus bacteremia in a cirrhotic patient with underlying hepatitis C. He presented with generalised abdominal pain associated with distention and could not ambulate for one week. He also complained of fever for six days and pruritus for 10 days. Tea-coloured urine was noted in continuous bag drainage. The abdomen was distended but soft, with mild tenderness palpated over the left lumbar and iliac region. Blood investigation indicated ongoing infection and inflammation. The aerobic blood culture was identified using the matrix-assisted laser desorption/ionisation-time of flight mass spectrometry and confirmed via 16S rDNA sequencing as V. vulnificus. Multilocus sequence typing of the isolated V. vulnificus revealed a novel sequence type, ST540. The patient responded well to the intravenous cefoperazone and was then discharged with a four day-course of oral ciprofloxacin, 500 mg twice daily after completing the intravenous cefoperazone for 10 days. Clinical history and physical examination are important for early antibiotic therapy initiation and appropriate surgical intervention. Furthermore, bacterial strain typing is also essential for epidemiological surveillance and potentially anticipating the pathogen's virulence traits, which are vital in controlling and preventing the spread of infection.
Factors influencing final year radiography students' intention to pursue postgraduate education in medical imaging

Mohamed A, Mat Sanusi NSA, Azman NS, Zailani NS, Jasmin NH, Che Isa IN

Radiography (Lond), 2024 Jan;30(1):388-393.
PMID: 38159357 DOI: 10.1016/j.radi.2023.12.006

INTRODUCTION: Postgraduate education in medical imaging is an important platform that can support in preparing radiographers for the role extension and advancement in radiography. Thus, this study aims to identify the factors influencing final year radiography students' intention to pursue postgraduate education in medical imaging.
METHODS: An online cross-sectional survey was conducted among final year students in medical imaging programs from six institutions in Malaysia. Purposive convenience sampling has been employed. Data collection was related to students' interest in postgraduate study and possible factors that may affect students' intention to pursue postgraduate education after study degree completion. The questionnaire was a combination of a Likert Scale and open-ended question.
RESULTS: A total of 148 (female, n = 132 and male, n = 16) responses were included in the analysis. Among the participants, n = 93 (62.8 %) of students intended to pursue study. The highest choice of study was mixed mode (41.9 %) and cardiac imaging was the field of choice by the students (22.3 %). Five factors have been found to significantly correlate with the students' intention to pursue postgraduate study in medical imaging which were student attributes, being an academician, remuneration, finance, and social influences (p 0.05).
CONCLUSION: Five out of seven factors tested were found to significantly influence students' decision to pursue postgraduate education in medical imaging. Effective strategies based on the influencing factors should be strategized to encourage more students to pursue postgraduate education in medical imaging.
IMPLICATIONS FOR PRACTICE: Implementation of effective strategies based on the influencing factors will improve access to education among radiography students, ultimately enhancing future radiographers' capability and competency.
Family study of haemoglobin Arya in a Malaysian family

Nahanthiran S, Nik Mustapha NH, Yasin N, Idris FB, Md Noor SB

Malays J Pathol, 2024 Aug;46(2):315-320.
PMID: 39207009

INTRODUCTION: Thalassemia and haemoglobinopathies are relatively common among Malaysians. One of the rare haemoglobinopathies reported is Haemoglobin (Hb) Arya, which occurs due to substitution of aspartic acid at residue 47 of the alpha chain by asparagine. Here, we report the detection of Hb Arya in a Malaysian family, which was detected incidentally during family screening.
CASE REPORT: A 16 years-old girl, clinically asymptomatic was noted to have low mean corpuscular haemoglobin (MCV) with normal Hb level. Hb analysis using capillary electrophoresis (CE) showed reduced Hb A of 76.5%, Hb A2 of 1.6% with presence of small peak at Zone 1 likely A2'. There was also a small peak noted at Hb D zone and Hb S zones which quantified as 1.5% and 20% respectively. Supplementary test by high performance liquid chromatography (HPLC) showed a prominent peak at D-window (19.6%) and a small peak at S-window (0.6%). DNA analysis revealed a heterozygous state of α2 codon 47 Hb Arya mutation. Subsequent family study showed a similar mutation in the father and sister of the index case.
CONCLUSION: Very few reports are available up to date regarding Hb Arya. This report highlights the rare haemoglobinopathy in a Malay family in Malaysia that contributes to the growing literature of this rare haemoglobin variant.
Nutritional evaluation of working Malay women in Kuala Lumpur as studied by total food duplicate method

Shimbo S, Moon CS, Zhang ZW, Watanabe T, Ismail NH, Ali RM, et al.

Tohoku J Exp Med, 1996 Oct;180(2):99-114.
PMID: 9111760

Nutrient intake was surveyed by the total food duplicate method in 49 adult ethnically Malay women (at the ages of 18 to 47 years and mostly at 30-39 years) working in Kuala Lumpur, Malaysia. Simultaneously, hematological examinations, serum biochemistry, anthropometry and clinical examination were conducted. Nutrient intakes were estimated in reference to the weight of each food item and the standard food composition tables. Lunch was the most substantial meal of the day with rice as a staple food. Compared with the Recommended Dietary Allowance (RDA) values, daily intakes of energy (1,917 kcal as an arithmetic mean), protein (62.2 g), vitamin B1 (0.83 mg) and vitamin B2 (1.18 mg) were sufficient, but intakes of minerals [i.e., calcium (347.8 mg) and iron (12.5 mg)] and some vitamins [i.e., vitamin A (equivalent to 627 micrograms retinol) and niacin (7.84 mg)] were less than RDA. When evaluated on an individual basis, the prevalence of those who took less than 80% RDA was highest for iron (92%), followed by niacin (80%), calcium (57%) and vitamin A (57%). The presence of 7 hypohemoglobinemia cases may be related to the insufficient iron intake. Overweight cases (14 women) were also detected, the prevalence of which increased at advanced ages. Lipid intake was rather high (28% of total food on energy basis), for which the major source was plants with limited contribution from fish/shellfish.
Knowledge, attitudes and practices on influenza a (H1N1) among Kelantanese schoolchildren

Wan-Arfah N, Norsa'adah B, Naing NN, Zaliha I, Azriani AR, Nik-Rosmawati NH, et al.

Southeast Asian J Trop Med Public Health, 2012 Nov;43(6):1489-501.
PMID: 23413714

Assessment of schoolchildren's knowledge, attitudes, and practices towards influenza A (H1N1) is crucial as schools play a major role in spreading the infection. The aims of this study were to determine the level of knowledge, attitudes, and practices on influenza A (H1N1) and the factors associated with practices of preventive behavior.A cross sectional study was conducted from July until December 2010. Two public secondary schools for two districts in Kelantan, Malaysia were randomly selected. Data were collected using a self-administered questionnaire. The questionnaire consisted of five constructs: sociodemographic, risk factors of containing influenza A (H1N1) infection, knowledge, attitudes, and practices. The questionnaire had been te,sted for its construct validity and reliability. General linear regression was applied in the data analysis. A sample of 436 secondary school students were recruited in this study involved Malay students aged 16 years old. The total knowledge, attitudes and practices scores for the overall respondents were 69.4, 82.2, and 73.8%, respectively. The significant influencing factors for the practices of preventive behavior were attended talk on H1N1 and attitudes score.This study suggested that health education is important for promoting the health of adolescents and contributing to the overall health of the public so that they will take precautions against the H1N1 infection.
The direct cost of treating bronchial asthma in a teaching hospital in Malaysia

Chan PW, Hussain S, Ghani NH, Debruyne JA, Liam CK

Southeast Asian J Trop Med Public Health, 2002 Sep;33(3):600-3.
PMID: 12693597

A pilot study to evaluate the direct cost of treating 51 adults and 50 children with bronchial asthma was conducted. All aspects of the medical care provided over a 6-month period were considered. The mean treatment costs per month were US dollars 22.97 (adults) and US dollars 15.56 (children). The cost of maintenance therapy accounted for 55.5% and 73.4% of the total direct cost treatment for adults and children respectively. Only 27 (52.9%) adults and 17 (34.0%) children paid for their inhaled prophylactic drugs, amounting to 12.3% of the total maintenance therapy costs. Thirteen (25.4%) adults and 9 (18.0%) children were using alternative therapy at a monthly cost of US dollars 41.50 and US dollars 16.77 respectively. A substantial proportion of the direct cost of asthma treatment is heavily subsidized in Malaysia. Adequate attention to the allocation of the health budget, to ensure the optimal provision of health care, is warranted.
Fulltext Semiquantitative screening test for G6PD deficiency detects severe deficiency but misses a substantial proportion of partially-deficient females

Ainoon O, Alawiyah A, Yu YH, Cheong SK, Hamidah NH, Boo NY, et al.

Southeast Asian J Trop Med Public Health, 2003 Jun;34(2):405-14.
PMID: 12971572

Neonatal screening for G6PD deficiency has long been established in many countries. The aim of the study was to determine whether the routine semiquantitative fluorescent spot test could detect all cases of G6PD deficiency, including those cases with partial deficiency (residual red cell G6PD activity between 20-60% of normal). We compared the results of G6PD screening by the semiquantitative fluorescent spot test and quantitative G6PD activity assay on a group of 976 neonates and 67 known female heterozygotes. The values for mean G6PD activity of G6PD-normal neonates and 293 healthy adult females were determined. There was no significant difference in the mean normal G6PD activity between the two racial groups in the neonates (669 Malays, 307 Chinese) and in the 293 healthy adult females (150 Malays, 143 Chinese) group. The values for the upper limits of total deficiency (20% of normal residual activity) for neonates and adult females were 2.92 U/gHb and 1.54 U/gHb, respectively. The upper limits of partial deficiency (60% of normal residual activity) were 8.7 U/gHb and 4.6 U/gHb respectively. The prevalence of G6PD deficiency among the male neonates was 5.1% (26) by both the fluorescent spot test and the enzyme assay method. The G6PD activity levels of all 26 cases of G6PD-deficient male neonates were < 20% normal (severe enzyme deficiency). In the female neonate group, the frequency of G6PD deficiency was 1.3% (6 of 472) by the fluorescent spot test and 9.35% (44 of 472) by enzyme assay. The 6 cases diagnosed as deficient by the fluorescent spot test showed severe enzyme deficiency (< 2.92 U/gHb). The remaining 38 female neonates had partial enzyme deficiency and all were misdiagnosed as normal by the fluorescent spot test. In the female heterozygote group, G6PD deficiency was diagnosed in 53% (35 of 67) by enzyme assay and in 7.5% (4 of 67) of cases by the fluorescent spot test. The 4 cases detected by fluorescent spot test had severe enzyme deficiency (<1.6 U/gHb). The remaining 31 (46.3%) cases, diagnosed as normal by fluorescent spot test, showed partial G6PD deficiency. In conclusion, we found that the semiquantitative fluorescent spot test could only diagnose cases of total G6PD deficiency and misclassified the partially-deficient cases as normal. In this study, the overall prevalence of G6PD deficiency was 3.28% by the semiquantitative fluorescent spot test and 7.17% by enzyme assay. This means that 3.9% of G6PD-deficient neonates were missed by the routine fluorescent spot test and they were found to be exclusively females. This study demonstrates a need to use a method that can correctly classify female heterozygotes with partial G6PD deficiency. The clinical implication is that these individuals may be at risk of the hemolytic complication of G6PD deficiency.
The use of an In House Scoring System Scale versus Glasgow Coma Scale in non-traumatic altered states of consciousness patients: can it be used for triaging patients in Southeast Asian developing countries?

Maheswaran M, Adnan WA, Ahmad R, Ab Rahman NH, Naing NN, Abdullah J

Southeast Asian J Trop Med Public Health, 2007 Nov;38(6):1126-40.
PMID: 18613557

Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS scale for the good outcome category. Multivariate analysis revealed that smokers and hypertensives were at higher risk for a poor outcome. Higher eye scores on the GCS were associated fewer poor outcomes. There was significant agreement between the IHSS scale and GCS scores in the assessment of non-traumatic ASC. The sensitivity and specificity of the IHSS score versus GCS were 71.9% and 100.0%, respectively.
In vitro evaluation of cytotoxicity and genotoxicity of porous nickel titanium dental implants produced by metal injection molding technique

N W N A M, R A, N H KA, E S, M A A K, M H I, et al.

J Biomed Mater Res B Appl Biomater, 2024 Jan;112(1):e35306.
PMID: 37522375 DOI: 10.1002/jbm.b.35306

Porous NiTi (pNiTi) is a promising biomaterial for functional long-term implantation that has been produced using various manufacturing techniques and tested for biocompatibility. pNiTi produced using a more recent technology of Metal Injection Molding (MIM) has shown better physical and mechanical properties than those produced by earlier manufacturing methods, but its biocompatibility has yet to be determined. Hence, extracts from pNiTi dental implants produced by MIM were tested for cytotoxicity and genotoxicity in this work. Its toxicity was evaluated at the cellular and in vitro levels using elution and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays. Short-term testing revealed that pNiTi extract was cytocompatible with L-929 fibroblast and V79-4 lung cells, with no cell lysis or reactivity observed, respectively (USP grade 0). Following exposure to varied extract concentrations, good cell viability was observed where the lowest concentration showed the highest optical density (OD) and cell viability (2.968 ± 0.117 and 94%, respectively), and the highest concentration had the least OD and cell viability (2.251 ± 0.054 and 71%, respectively). pNiTi extracts demonstrated genocompatibility in two independent assays: mutagenic potential using a bacterial reverse mutation test and a clastogenic effect on chromosomes using the micronucleus test. Similar to the negative control reactions, there was no significant increase in revertant colonies following exposure to 100% pNiTi extract with and without metabolic activation (p = .00). No DNA clastogenic activity was caused by pNiTi at varied extract concentrations as compared to the negative control when tested with and without metabolic activation (p = .00). As a result, both cytotoxic and genotoxic investigations have confirmed that pNiTi dental implants utilizing the MIM process are cytocompatible and genocompatible in the short term, according to the International Standard, ISO 10993 - Parts 3, 5, and 33.
Fulltext Factors influencing pregnancy planning of multi-ethnic Asian women with diabetes: A qualitative study

Z I I, C J N, P Y L, N H

PLoS One, 2020;15(12):e0242690.
PMID: 33270663 DOI: 10.1371/journal.pone.0242690

INTRODUCTION: Pregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women's pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women's pregnancy planning.
METHODS: This qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis.
RESULTS: From the 33 interviews that were analysed, four important factors influencing participants' decisions regarding pregnancy planning were identified. Participants' perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious 'up to God' beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care.
CONCLUSIONS: This study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.
Fulltext Tobacco & E-cigarette Survey Among Malaysian Adolescent (TECMA) 2016

Aris T, Abd Ghani AA, Mohd Yusoff MF, Robert TG, Tee GH, Mohd Hasri NH, et al.

ISBN: 978-983-2387-30-5

Citation: Aris T, Abd Ghani AA, Mohd Yusoff MF, Robert TG, Tee GH, Mohd Hasri NH, et al. Tobacco & E-cigarette Survey Among Malaysian Adolescent (TECMA) 2016. Kuala Lumpur: Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia; 2016
Prevalence of iron deficiency anaemia and thalassaemia trait among undergraduate medical students

Azma RZ, Ainoon O, Azlin I, Hamenuddin H, Hadi NA, Tatt WK, et al.

Clin Ter, 2012 Jul;163(4):287-91.
PMID: 23007811

Anaemia is a global health problem including Malaysia. In adults, anaemia may affect work productivity. Iron deficiency anaemia and thalassaemia are common causes of anaemia in Malaysia. However, there is scarcity of data on national prevalence of iron deficiency anaemia and thalassaemia, especially in young adults. This cross sectional study was performed to determine the prevalence of iron deficiency anaemia and thalassaemia among medical students of Universiti Kebangsaan Malaysia Medical Centre (UKMMC).

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